• Aetna is one private insurance company that offers Medicare Advantage plans.
  • Aetna offers HMO, HMO-POS, PPO, and DESNP Advantage plans.
  • All Aetna Advantage plans may not be available in your area.

Aetna is a health insurance company based in Connecticut. They are one of many private insurers that Medicare has approved to sell Medicare Advantage (Part C) plans.

Aetna offers a wide range of Medicare Advantage plans that are designed to fit multiple budgets. Not every plan is available in every state, county, or zip code. Based on where you live, Aetna Medicare Advantage plans you may be able to join include:

  • HMO: health maintenance organization plans
  • HMO-POS: point of service (POS) organization plans
  • PPO: preferred provider organization plans
  • DESNP: dual-eligible special needs plans

This article will go into depth about Aetna’s Advantage plans and their Part D prescription drug plan offerings.

Medicare’s Find a Medicare plan tool can help you review Medicare plans available in your area. You will need to enter your zip code.

Medicare Advantage (Medicare Part C) plans cover at least as much as original Medicare (Part A and Part B) plans do. They are popular because they usually provide extras, such as dental, vision, and hearing coverage. Some Part C plans include prescription coverage as well, so that you don’t have to opt into a Part D plan.

There is a wide range of Part C plans that accommodate a wide range of household budgets.

Not every plan is available everywhere. Your state, county, and zip code will determine which plans you can join. The costs for each plan vary by location as well.

Here are quick guides for understanding Medicare Part A, Medicare Part B, and Medicare Part C (Medicare Advantage).

Here are the details of the four Aetna Medicare Advantage plans.

Aetna Medicare Advantage HMO plans

Cost

Monthly premiums for Aetna HMOs range from $0-$178.

These plans limit what you will pay out-of-pocket annually and have an annual medical deductible of $0-$1,180.

Coverage

HMO plans are typically the most affordable option of the Advantage plan offerings provided. Aetna’s HMOs require that you choose an in-network primary care physician (PCP). You will have access to a specified network of doctors and hospitals that includes specialists.

You will need a referral from your PCP to see a specialist. In the case of an emergency, you will be able to use an out-of-network doctor, ER, or hospital. You will also get an over-the-counter medication benefit that will provide free access to many products.

Most plans include prescription drug coverage and offer a mail order prescription drug benefit. All plans include worldwide ER and urgent care coverage.

Most plans offer extras, such as dental, hearing, and vision coverage. A free gym or health club membership to participating facilities is included in all plans through the SilverSneakers® program.

Some plans provide free access to non-emergency ambulatory services and access to free meals at home, after a hospital stay.

Aetna Medicare Advantage HMO-POS plans

Cost

Monthly premiums range from $0-$33.

These plans limit what you will pay out-of-pocket annually and have an annual medical deductible of $0-$500.

Coverage

HMO-POS plans are HMOs that include an out-of-network option. Plan members may access medical treatment outside of their HMO network for specific treatments or under special circumstances. With an Aetna HMO-POS plan, you will typically pay more to see an out-of-network doctor.

Some Aetna HMO-POS plans will require that you choose a primary care physician. Some will also require that you obtain a referral for specialists from your PCP.

All plans include prescription drug coverage and a prescription drug mail order benefit, worldwide ER and urgent care coverage, and an over-the-counter medication benefit that will provide free access to many products.

Most plans offer extras, such as dental, hearing, and vision coverage. A free gym or health club membership at participating facilities is included in all plans through the SilverSneakers® program.

Some plans provide free access to non-emergency ambulatory services and free meals at home, after a hospital stay.

Aetna Medicare Advantage PPO plans

Cost

Monthly premiums range from $0-$214.

These plans limit what you will pay out-of-pocket annually and have an annual medical deductible of $0-$1,800.

Coverage

Aetna PPO plans let you use any doctor, in and out of network, provided that they accept Medicare and Aetna’s plan terms. Seeing an out-of-network provider will typically cost more.

You are not required to choose a PCP and do not need referrals to see specialists.

Most plans include prescription drug coverage, a prescription mail order benefit, and an over-the-counter medication benefit.

Most plans include extras, such as dental, vision, and hearing coverage. A free gym or health club membership to participating facilities is included in all plans through the SilverSneakers® program.

Some plans provide free access to non-emergency ambulatory services and free meals at home, after a hospital stay.

Aetna Medicare Advantage Dual-Eligible Special Needs Plans (DESNP)

Cost

If you qualify for Medicare and Medicaid AND live in an Aetna service area, you may qualify for a dual-eligible special needs plan. These plans may be free with no-or-low copays, premiums, or coinsurance.

Coverage

Most of these plans include access to a personalized care team.

Some provide extras such as dental, hearing, and vision coverage. Prescription drugs and over-the-counter Medicare-approved medications are also covered.

Many plans include health and wellness programs, fitness programs such as SilverSneakers, and access to treatments such as acupuncture.

Aetna offers these DESNPs in 14 states:

  • Alabama
  • Florida
  • Georgia
  • Iowa
  • Kansas
  • Louisiana
  • Missouri
  • Nebraska
  • North Carolina
  • Ohio
  • Pennsylvania
  • Texas
  • Virginia
  • West Virginia

Stand-alone prescription drug plans (PDPs) provide coverage for most medications. The drugs covered vary by plan. If you have decided to stay with original Medicare (parts A and B) instead of a Part C Advantage program, you will also need to enroll in a Medicare Part D plan.

Aetna’s Part D offerings are referred to as SilverScript Part D plans. There are two types. Both offer a mail order benefit and require you to use Medicare-approved pharmacies. Each plan is available everywhere in the U.S. except for the Plus plan, which is not available in Alaska:

  • SilverScript Choice. This plan is usually the most affordable, based on your zip code. It offers many generic and brand-name medications. Most medications have a $0 deductible. Some medications will require a co-pay. This plan has an average monthly premium of $21-$58.
  • SilverScript Plus. This plan offers more medications than the Choice plan, both generic and brand-name, without a deductible. Some medications have a $0-$2 copay. This plan has an average monthly premium of $57-$101.

In order to be eligible to purchase a Medicare Advantage plan, you must be eligible for, and enrolled in, original Medicare (parts A and B).

Since not every plan is available in each state, you must also live where the plan is offered.

If you have end stage renal disease, you may not be eligible for a Medicare Advantage plan.

There are several times when you can enroll in or change your Part C coverage:

DeadlineEnrollment dates or period
Initial enrollmenta 7-month period starts 3 months before you turn 65 and ends 3 months after your birthday occurs
General enrollmentJanuary 1 – March 31 each year
Post General EnrollmentIf you enroll in traditional Medicare (parts A & B) during General enrollment, you have a 3 month window (between April 1 – June 30) to enroll in a Part D drug plan or switch to an Advantage plan.
Open enrollmentOctober 15 – December 7 each year
Plan change enrollmentOctober 15 – December 7 each year
Special enrollmentSpecial enrollment periods are triggered by events in your life that cause you to lose your current health coverage. Special enrollment periods last for 8 months after the date of the triggering event.

Aetna offers many Medicare Advantage (Part C) plan options. These vary by cost and offerings. Your state, county or residence, and zip code will determine which plans you have to choose from. You must be eligible for original Medicare in order to join a Medicare Part C plan.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

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